<?xml version="1.0" encoding="UTF-8"?>
<view:module class="base" id="instance" xmlns="http://www.w3.org/1999/xhtml" xmlns:debug="http://nuxleus.com/session/debug" xmlns:request="http://nuxleus.com/session/request" xmlns:session="http://atomictalk.org/session" xmlns:geo="http://nuxleus.com/geo" xmlns:doc="http://atomictalk.org/feed/doc" xmlns:view="http://atomictalk.org/page/view">
  <div class="form" id="pledgeSupport">
    <h1>Pledge your support 4Lessig 4Congress!</h1>
    <form id="lessig" method="POST" action="/service/4lessig/add-support/" target="_top">
      <div id="pledgeSupportDiv">
        <div class="formRow">
          <ul class="LtoR row">
            <li class="left">
              <label for="name">Name:</label>
            </li>
            <li class="right">
              <input class="text" type="text" name="name" id="name" />
            </li>
          </ul>
        </div>
        <div class="formRow">
          <ul class="LtoR row">
            <li class="left">
              <label for="email">Email:</label>
            </li>
            <li class="right">
              <input class="text" type="text" name="email" id="email" />
            </li>
            <li class="left">
              <label for="email">Zip:</label>
            </li>
            <li class="right">
              <input class="zip" type="text" name="zip" id="zip" />
            </li>
          </ul>
        </div>
        <div class="formRow">
          <ul class="LtoR row">
            <li class="left">
              <label for="location">Location:</label>
            </li>
            <li class="right">
              <select class="location" name="location" id="location">
                <option>Please select the closest match...</option>
                <option value="ca12thdistrict">California 12th District</option>
                <option value="bayarea">Bay Area</option>
                <option value="ca">California</option>
                <option value="usa">United States</option>
                <option value="international">International</option>
              </select>
            </li>
            <li class="right">
              <input type="submit" name="submit" id="submitPledge" value="Make My Pledge!" />
            </li>
          </ul>
        </div>
      </div>
    </form>
  </div>
</view:module>
